Claims Integrity Analyst

Cobalt Benefits Group • South Burlington, VT

4d • Onsite

About The Position

The Claim Integrity Analyst supports the Claim Integrity Lead in identifying, analyzing, and validating claim payment discrepancies and recovery opportunities for external clients. This role plays a key part in data mining, anomaly detection, and claim review activities, with a strong focus on medical coding accuracy, provider contracting, pricing logic, and reimbursement policies. The analyst partners closely with internal teams, business partners, and vendors to help execute claim integrity initiatives and deliver high-quality, compliant outcomes.

Requirements

• Active CPC certification required.
• 3–5 years of experience in healthcare billing, claims processing, coding, or experience with a health insurance carrier or third-party administrator strongly preferred.
• Strong working knowledge of medical terminology, claim edits, and industry-standard reimbursement practices.
• Demonstrated analytical skills with the ability to research, interpret, and explain claim findings.
• Excellent time-management skills with the ability to prioritize multiple tasks in a fast-paced environment.
• Strong verbal and written communication skills.
• Proficiency with Microsoft Office 365 applications.

Responsibilities

• Support the Claim Integrity Lead in claim integrity initiatives, including concept validation, data analysis, and ongoing program refinement.
• Analyze large and complex claims data sets to identify trends, anomalies, and potential overpayment or recovery opportunities.
• Investigate and research claims using medical coding guidelines, payer policies, and reimbursement standards.
• Act as a liaison with internal departments, business partners, and external vendors to support claim integrity activities.
• Serve as a subject-matter resource for business partners by addressing questions, discrepancies, and claim integrity findings.
• Document client-specific processes, procedures, and validation methodologies in accordance with established standards.
• Manage assigned work queues and projects, prioritizing tasks based on business needs and deadlines.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Employer HSA contributions
• Company provided Basic Life and AD&D
• Company paid Short-Term and Long-Term Disability
• Flexible Spending Accounts
• 401(k) Retirement Plan with up to a 6% employer-match
• 10+ paid holidays
• Generous paid vacation and sick time
• Annual Volunteer Paid Day
• Annual Tuition Reimbursement
• Annual Health and Wellness Reimbursement
• Company events

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed